Price Transparency: The Business Of Front-end Operations

Originally Published in ASC Focus

The growth of consumerism and the need for healthcare cost-containment has resulted in the Department of Health and Human Services hospital price transparency ruling which went into effect January 1st of 2021. While this ruling and its applicable requirements apply directly to hospitals, there is no denying that all of healthcare, including Ambulatory Surgery Centers (ASC), physician offices, and other providers, are focused on transparency and costs. In addition to federal action, many states are passing legislation that would require health care providers make costs and other information available to consumers via their websites or other direct means with the goal of supporting patient rights to informed healthcare choices. With this understanding, ASCs can be proactive by investing in front-end operations that will increase cash flow, while ensuring compliance with price transparency requirements.

One of the first opportunities to provide price transparency to patients while also ensuring you are maximizing your revenue is through proper capture of patient demographic information and insurance verification. It is vital that patient registration and scheduling be an accurate and efficient process as this is often one of the first and most critical steps in the revenue cycle process. Issues with patient demographic capture and eligibility can result in the misquoting of patient responsibility but can also result in rejected or denied claims which will have an immediate impact to cash flow. Implementing technology that can accurately capture demographic information and confirm patient eligibility is one of the simplest ways to help eliminate claim rejection and denials, which in turn improves clean claim rates and increases cash flow.

ASCs can also increase price transparency through the proper quoting of patient responsibility at time-of-service. Patients have become one of the primary payers in healthcare today due to the rise of high-deductible health plans, but also due to the rise of consumerism and the ability to search and shop for services. A recent TransUnion study showed that roughly 70% of patients are not paying their financial responsibility after services have been provided and as such, ASCs must shift their focus to improving time-of-service collections. To help providers collect these higher patient responsibilities many practices are implementing new technologies and automated tools to accurately evaluate patient benefits and eligibility and produce accurate time-of-service patient responsibility quotes. These estimates also offer providers the supportive and accurate information needed to discuss personal and customized financial responsibility with their patients during financial counseling.

Another service that is conducive to increasing patient collections while providing patients with transparency of healthcare cost, is the offering of an online payment option through portal or other mode. Some recent research suggests that patients are displaying an overwhelming willingness to pay health care bills online and via mobile devices with 80% of patients preferring digital patient payments in their clinician offices. Providers should consider adopting electronic bill pay to not only meet consumer needs, but to also help eliminate burden on staff and increase collections through consumer ease of use.

We know that patients are becoming increasingly educated about their healthcare choices and with current legislative actions focused on price transparency, we can only expect that patients will increasingly expect full visibility of healthcare costs. Many facilities are beginning to take advantage of new methods to improve front-end operations to stay ahead of the curve. Investing in new technologies and resources that ensure your organization is compliant with price transparency regulation, automate patient demographic and eligibility capture, and increase ease of use for patients will ensure your facility is meeting the needs of your patients while having a positive impact to your overall revenue.

By Kylie Kaczor, MSN-RN, CASC, CPCO, CPHRM, CLSSBB, CMPE, ACHE, Senior Vice President, Clinical & Regulatory Affairs, National Medical Billing Services


This post was first published October 1, 2021 and was updated May 31, 2022.

Kylie Kaczor, Vice President, Clinical and Regulatory Affairs

Kylie Kaczor - MSN-RN, ASC, CMPE, CPHRM, CLSSBB, CPCO, ACHE Vice President, Clinical and Regulatory Affairs Kylie has been a registered nurse for over 13 years with experience in intensive care nursing and outpatient surgery. She holds a Master of Science in Nursing: Leadership and Health Systems Management degree from Drexel University. Over the past several years, Kylie has served as Executive Director of multiple ambulatory surgery centers using her unique clinical background and understanding of operations to drive quality in patient care. and organizational development and growth. She is passionate about the cultivation of high-performing teams and invests extensive time in coaching and mentoring both healthcare and business professionals. Kylie has specialized in several areas during her career resulting in certifications in ambulatory surgery center administration, medical practice operations, healthcare risk management. She is a Certified Lean Six Sigma Black Belt focused on operational efficiency and practice improvement. Kylie serves as National Medical’s Compliance Officer and remains active in Washington, DC visiting Capitol Hill and meeting with lawmakers to further healthcare reform efforts. Her distinctive experience in healthcare services and business operations allows Kylie to provide National Medical’s clients with supportive collaboration as they effectively operate their facilities through an ever-changing healthcare climate.

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